Why are triage tags important? The obvious answer is: They allow us to indicate the priority of our patients, which provides a snapshot of the patient's medical condition at the time triage is performed. Tags also allow the providers who are moving patients to the treatment area to locate and move the most critical patients (e.g., the "reds") first.

Further, they assist the providers assigned to perform a secondary triage at the entrance to the treatment area to see what the field-triage providers believed the patient's condition to be. This provides "trending" information.

A patient may have been triaged as yellow or green, but if upon reaching the treatment area they are unresponsive or in marked distress—signifying the patient is now a red—it's assumed the patient's condition is deteriorating. On the other hand, if the patient was triaged red but there are now no reasons to believe the patient is in imminent danger, it can be assumed that the patient's condition has improved.

Additional Benefits of Tags
But triage tags or ribbons do more. They not only serve as a visual indication of the patient's condition but also demonstrate the patient was evaluated and is now part of the "system." This expedites patient care and also saves valuable time and resources.

Because triage tags can be used to indicate an individual was involved in an incident, some triage-tag manufacturers now include a white bar noting the patient was involved but not injured. This clearly shows the person was evaluated by triage personnel and allows them to be entered into a tracking system. But because the tag also indicates the patient is uninjured, they don't need to be placed in the treatment area where they could tie up limited resources. If the patient develops symptoms later that require treatment, it's simple to change the tag color.

The use of tags also reduces the potential for redundant operations that waste time. At an MCI in San Francisco that involved more than 18 pedestrians struck by a bus, the first unit on scene triaged the patients but didn't tag them. The patients all had to be triaged a second time so that tags could be applied to expedite treatment and transportation of the most critical.

On the other hand, some have argued that triage tags aren’t necessary at an MCI. After providers noted the lack of triage tags at the crash of United Airlines flight 232 in Sioux City, Iowa, didn't seem to have a negative effect on triage operations, it caused some EMS agencies to reevaluate whether they'd use tags at an MCI. However, this incident can't be used as a basis to say triage tags aren't useful or needed for most MCIs due to the amount of resources that were already present at the airport prior to the crash, including 285 national guardsmen who assisted with the operation, and that the incident was in a secured area. Some may argue that the people on the scene served as human triage tags, relaying information to other medical providers that otherwise may have been transmitted via tags.

Making the Best Use of Tags
But just because we have or carry triage tags doesn't necessarily ensure their use, nor does it mean we're familiar with them. For example, about three months before the bus crash in San Francisco, the city experienced an MCI involving an explosion at a restaurant. In that case also, paramedics mentioned that although they carried tags on their ambulances, they weren't used until later in the incident. They also believed the operation would have benefited had tags been used earlier. So, what can we do to avoid this mistake and get the most from this simple piece of equipment? Let's consider a few things.

Location: Do all our first-line response vehicles carry triage tags or ribbons, and do all our providers know where they're located on the vehicles? Typically, one of the first units on the scene of an MCI needs to begin triage. If EMS providers have to wait for a supervisor's vehicle, an ambulance or a mass casualty vehicle to arrive with tags, triage will be impeded. Additionally, if they can't quickly find the tags, they're less likely to use them.

Familiarity: Do the hospitals know how to interpret our tags? This is another factor we should consider. The time for emergency department staff to figure out what the card dangling from the patient's wrist is for is not when the patients start flowing through the hospital doors. Additionally, some triage tags have different ways of indicating whether patients were decontaminated, so hospital personnel need to be familiar with the tag you use in your area. Communicate with your local hospitals so that they can be confident they aren't receiving contaminated patients in the event of a weapon of mass destruction or haz-mat MCI.

Training: Do our providers know how to use the triage tags we carry? Every tag is slightly different in both layout and areas for writing information collected. Providers need to know how to use each part of the tag and how these affect other parts of our MCI operations.

Practice: Have providers practiced affixing the tags to patients, writing on the tags or using the tags features with gloved hands? This will help them get a feel for using real tags, as well as maintain their familiarity with the tag. Some EMS agencies have a day of the week when they place a triage tag on every patient. Implementing a "Triage Tuesday" type of training does cost a little, but the benefits will be noticeable in the event of an MCI.

Training and practice should also include what may seem like a simple task: carrying tags or ribbons. Because it takes two hands to place a tag or ribbon on a patient, having a consistent means of carrying the tags or ribbons (e.g., a waist pack) will expedite triage operations. A pack can also be used to hold ancillary supplies. Triage providers should limit treatment to life-threatening conditions. But, it's difficult to control bleeding or maintain an open airway to quickly correct the problem if equipment isn't readily available.

Some EMS agencies have found that adding such items as combat-style dressings, tourniquets, oral airways and a pair of trauma shears to the waist pack holding the triage tags or ribbons gives providers one place to carry everything. ALS providers may also benefit from having a few long, large-bore IV catheters in the pack to relieve a tension pneumothorax if needed.

Yes, triage tags may appear to be a simple piece of equipment. But as we’ve seen, there's more to this simple tag than meets the eye. With a little bit of planning and training, we can get the maximum benefit from this tool when we need it the most.

Daniel Mack, NREMT-Pis assistant chief of Miami Township Fire & EMS, Cincinnati, and a member of the Cincinnati area UASI group and Hamilton County USAR Team. He can be contacted at danmack2@yahoo.com.